While growth rates are loosely correlated with the overall degree of renal dysfunction (4), the individual degree of growth impairment is believed to reflect variable contributions of individual endocrine and metabolic complications of CKD including accumulation of inhibitors of growth hormone (GH) and insulin-like growth factor (IGF)-1 signaling, the malnutrition-inflammation complex, metabolic acidosis, renal anemia, and hyperparathyroidism (5). Here, GH1 is linked to metabolic acidosis.